Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 315

Unfortunately, despite standard one of the UK’s National Service Framework for Older People in 2001 being ‘rooting out age discrimination’, there is still evidence that negative attitudes toward older people, including ageism, can result in poor quality of care and problems with patient safety.⁵³ Ageism is the act of discrimination against people on the grounds of age alone. Commonly cited consequences are that older people may be denied treatment or investigations that may benefit them or may be subject to mislabelling or misdiagnosis.⁵⁴ For example, several studies show that older people with ischaemic heart disease are less thoroughly investigated and receive less interventional treatment than younger patients, even when it is clinically indicated.⁵⁵ This is despite growing evidence that older people are likely to experience substantial benefit in terms of quality and length of life from appropriate cardiac interventions. Such differences may occur not as a result of overt ageism but rather due to uncertainty about the best and safest clinical practice in this age group, particularly among those who are not specialists in caring for older patients. Of course, one of the unique skills of geriatricians is striking the correct balance for the individual patient between therapeutic nihilism (the avoidance of treatment entirely) and therapeutic heroism (where all interventions and treatments are given, even when there is unlikely to be any therapeutic benefit).

The care of older people in general is regarded by some within the healthcare profession as a specialty with very little reward (in terms of clinical outcomes or prestige) for sometimes very heavy physical work. This can lead to staff feeling undervalued and lacking in motivation to implement change. There can also be a negative attitude toward patients, leading to reduced dignity, loss of patient empowerment, and a sense of infantilization. One of the observable manifestations of this is elderspeak, where patients, particularly those with cognitive or sensory impairment, are talked down to as if they are children; this lack of meaningful interaction can contribute to depression and cognitive and functional decline.